So by the title you understand my predicament. I’ve been loosing vocal quality for 4 years now and everyone attributed it to bad technique, eve though my voice was always way more flexible than it is now and I noticed a clear drop in every quality of my voice. By instinct I knew something was wrong.
I spent 3 years going from maxilofacial to ENT to dentist to fisiotherapist and endef up at an ENT who decided finally to do a neck CT. And there it was. Stylohyoid process elongation with apparent calcification of the styloid ligament.
Now, according to what I know, operating is the only solution to solve this problem. Seeing as this is my only job, my life, my existence, can I find a doctor that does an intra-oral approach? It minimizes the effects on the muscles and nerves that I so cherish. If they cut me across the sternocleidomastoideus undrr the ear that will bring many complications and not only that but make sure I’ll spend at least two years recovery and maybe 2 more getting up to speed on my singing again.
I’m from Portugal and I don’t know if this is the best country to have this kind of operation done… Maybe somewhere else in Europe is more appropriate. I need them to pick at my throat as if operating on a baby.
Also, they will probably remove the stylohyoid ligament as well, right? That has no implications on the voice, or so chat gpt tells me. Has anyone who has had the ligament removed confirmed that their absence is not important for singing?
I could really use some help, I’m becoming increasingly stressed and depressed and angry at all this because I had plans for the next 5 years to go to France and start my career there with my girlfriend and all that went to the trash because I happen to be in the few 4% of 4% who have issues with the styloid process… Thank you for your attention
@Miguelreis - I’m so sorry this has happened to you. I understand how severely this could impact your career & future plans. We have some members who are professional singers, but they stopped posting on the forum after they had their ES surgeries. With the exception of @MusicGeek, we haven’t heard how their voices recovered. I suspect some had good recovery & were able to return to their careers whereas others may not have fully recovered their former vocal range, however, they didn’t lose the ability to sing.
I’m glad you know that surgery is the only cure for ES, but I disagree with you that intraoral surgery is the right type of procedure for you. Intraoral surgery often requires that the tonsils on the affected side be removed then an incision is made directly in your throat behind the tonsils to access the styloid process. If the stylohyoid ligament is calcified & needs removal it is often inaccessible via the intraoral route so external surgery would be used to remove it. Intraoral surgery has a much higher infection rate than the transcervical approach (through the neck) & is also more painful & slower to heal. As a singer, I think you would appreciate not having someone making incisions in your already compromised throat area.
There are a number of approaches doctors use for the transcervical approach & one of the more popular is to make an incision in a neck crease, which, when healed, is nearly invisible. This allows better access to the styloid so it can be cut back as close to the skull base as possible, & the stylohyoid ligament can also be removed. It allows nerves, muscles, tendons & ligaments to be visualized so they can be protected during surgery. Cutting out muscle is not typical of this approach though sometimes a small part of a muscle needs removal if it has adhered to the styloid or is causing nerve compression, but this doesn’t usually affect vocalization or swallowing once healed. Unlike transcervical surgery, the surgeon doing intraoral surgery is cutting blind i.e. unable to see any of the structures I mentioned as (s)he cuts into the tissue in the throat.
It takes about 2 mos. after transcervical surgery for one’s energy to return fully & by 4-6 months many of the symptoms of ES will be gone, but it can take up to a year for the affected nerves to heal completely. The stylohyoid ligament plays a very minor role in swallowing & those of us who’ve had it removed don’t miss it. It does not have an effect on the vocal cords & therefore on singing.
We don’t know of any doctors in your country who do this surgery though seeing an ENT who is a skull based surgeon (often these doctors are cancer specialists) would be a good place to start. Otherwise, there are some very good ES surgeons in England. We can give you specific names if you’re able to travel.
Whatever happens, we’re here for you & I will be praying for you to find the very best surgeon to help save your voice.
@Isaiah_40_31 Thank you so much for the care and attention you took with your response.
I now understand that it is in fact more intelligent to consider the transcervical as it involves much less of the voice box, my money maker. Now let’s just hope the doctor I find can fix me without damaging anything else.
If you could recommend UK doctors that could be sensible enough to consider all avenues of approach to my problem and take into account that losing my voice would be losing my being I would greatly appreciate it. I need someone who is experienced and knows how to minimize risk to surrounding muscles and structures.
My greatest thanks for the care you show with my problem.
As a service to this community, as soon as I get my surgery I promise to post updates post surgery and after a few months and, if I remember, after a year. I feel like professional singers need to have some sort of report of post operatory situations from fellow colleagues.
P. S. How are you doing now? How long ago was your surgery? Any symptoms? What changes do you feel?
The doctor’s list I sent you a link to has the UK doctors on it, either Mr Axon in Cambridge or Mr Hughes in London are the most experienced…I agree with @Isaiah_40_31 that the external surgery would be better, Mr Axon is very careful to go between muscles so none are cut, his excision is behind the ear. Not sure about Mr Hughes, others can answer that…
I had my first surgery on 11/14 & my second one on 8/15. These surgeries got rid of about 95% of my symptoms. I still get an occasional nerve twinge that lasts for a few seconds, but that’s far better than being in constant pain.
My first surgery was close to 2 hrs because my glossopharyngeal nerve was wrapped around my styloid & had to be unwrapped so the styloid could be shortened. Half of my tongue was paralyzed because of the irritation to that nerve & took about 9 months to recover, but it’s fine now. The second surgery was a little over an hour & was much more straight forward.
J****. Living with the tongue issues must have been hell…
Is it common for the nerve to be around the ligament like that? Do you notice any differences in speaking or swallowing? Any differences in your voice?
Hi @Miguelreis - We’ve had a few members who’ve had the same problem I had w/ the glossopharyngeal nerve but as far as I know their tongue paralysis healed w/ time. This is NOT a common problem w/ ES.
My tongue has healed 95%. On some days I feel like I don’t articulate my words as clearly, but no one notices except me. I occasionally have a day where I choke when I take a drink, but that was happening before I had my ES surgery, so I think it’s unrelated to the tongue issue. My voice hasn’t been affected, however, one of the odder symptoms I had before my ES surgeries & which I still have, is the feeling that my throat, jaw & neck get very tense when I sing during worship time in a church service. If I sing an octave lower than what feels natural that tenseness goes away. I’ve experimented w/ different ways of breathing during singing to see if that helps, but I haven’t found the solution for this problem yet, in part because I’m not sure what’s causing it.
Well maybe then I’ll be part of the lucky ones who don’t have that…
Glad to know you’re mostly back to shape. I’ve had some choking issues but I notice they get worse when my ES is worse so it’s probably related.
The vocal tension may very well be technique, I’ve known people who’ve sung in choirs all their lives and always sung with tension, specifically in the high range, which tends to make our body work overtime to produce those notes. But because we aren’t used to using the right muscles to achieve the high notes we tend to compensate with the wrong ones and create tension. Maybe that’s it. Probably just going about it the wrong way, which is very common and understandable. Thank you for the info.
Choking was my first ES symptom. I had to have the Heimlich Maneuver a couple of times (very embarrassing but also life saving!!). After an upper GI determined nothing was wrong in my esophagus or throat, the more obvious ES symptoms began to develop which initially was pain in the front of my neck. Then I found a hard, tender lump under my jaw on the left side. I saw a couple of doctors for that before being referred to the ENT who diagnosed me.
Fortunately my choking never got that harsh. I usually just choke on my drink here and there. But I do have a clicking sound when I swallow which is very annoying and makes swallowing slightly uncomfortable.
The click when swallowing comes from your hyoid bone being “tethered” by the calcified ligaments. Normally it moves up & down freely when swallowing, singing, coughing, sneezing, breathing, etc. Once it’s freed from the calcified ligaments it will be quiet when you swallow.
Hi, on Mr Hughes I can confirm he uses neck crease incision. He does need to move nerves & in my first 2 surgeries the op report talks about dissecting digiastic muscleI recall. But I felt no lasting effects from that after healed. My revision surgery to skull base on right has resulted in more nerve issues, despite nerve monitoring, but Mr Hughes seems confident time will heal this. He is a very good surgeon and very few ENT surgeons will agree to do skull base removal advised for ves patients. In my case Mr Axon has refused to help over last 2 years. Mr Obholzer is a new Uk surgeon members are seeing. I do not know him. Others might. Hope you get help you need. D
Thank you so much for your testimony. I’ve had stellar reviews from patients of both doctors so I’ll probably ask then both for an opinion. I am expecting a grueling recovery but as long as I eventually get back in shape it doesn’t matter how long it takes. Thank you very much for your support. It means the world to me.
@Miguelreis - I hope you find the best possible doctor to do your styloidectomy & give your voice back to you. We’ve had several professional singers come through here & only a few have come back to report how they were doing. In most cases vocal quality was restored.
Thank you for the kind words. I intend to report back monthly with reports on my recovery. I also intend to make a YouTube video to show my scars and maybe talk about the recovery and the post op effects. Being a singer with this syndrome, especially of an uncommon genre like opera, I feel like I need to give my testimony. And here’s hoping it’s a good one cheers
Here’s hoping! Although if my scars are visible maybe my recovered voice will make up for it!
Don’t worry, I have made it a goal to keep you posted and to make that video. It’s my duty as a singer with this issue.
cheers